Surgical Delivery of Drug Shows Promise Against 'Bleeding' Stroke

THURSDAY Feb. 7, 2013 -- Stroke patients who had surgery to deliver the powerful clot-busting drug tPA directly into the brain had better and quicker recovery than those who received standard treatment, a small new study finds.

The researchers looked at 96 patients, aged 18 to 80, who suffered an intracerebral hemorrhage, a type of stroke caused when a blood vessel ruptures in the brain.

According to the team from Johns Hopkins University School of Medicine, in Baltimore, intracerebral hemorrhage has long been considered surgically untreatable in most cases. About 50 percent of people with this type of stroke die. It is much less common than ischemic stroke, which is caused by a clot in a blood vessel in the brain.

One expert not connected to the study said that although people with a stroke caused by a clot often get the clot-busting drug tPA (tissue plasminogen activator), that's not the case for less common bleeding strokes.

"Historically, patients with bleeds into their brain were either observed or underwent cranial surgery to remove the clot and alleviate the intracranial pressure," said Dr. David Langer, director of cerebrovascular research at North Shore University Hospital in Manhasset, N.Y. "Clot-busting drugs were not utilized for fear of aggravating the problem by potentially causing more bleeding."

In the new study, however, some of the patients underwent surgery to deliver tPA directly into the golf-ball-sized blood clots in their brain. For this procedure, doctors drilled a dime-sized hole in the patient's skull, placed a catheter in the hole and then guided it to the clot. Small doses of tPA were dripped through the catheter for several days.

Another group of patients received more standard therapy, which essentially gives clots a chance to shrink on their own.

The researchers reported that blood clots shrank by about 20 percent a day for the patients who got tPA and by about 5 percent a day for the standard-therapy patients.

Those in the tPA group had a quicker recovery and went home from the hospital an average of 38 days sooner than those in the standard-therapy group, resulting in estimated health care cost savings of $44,000 per patient, according to the study.

"This is the most promising treatment that has come along in the last 30 or 40 years for people who have suffered hemorrhagic stroke," study leader Dr. Daniel Hanley, a professor of neurology at Johns Hopkins, said in a university news release.

Hanley said the next step is to conduct a larger study of 500 patients in order to confirm the benefits of the tPA therapy.

For his part, Langer said he was cautiously optimistic about the therapy. "More work will be needed to fully understand the effects of these powerful drugs," he said, "but this preliminary work represents real progress in the development of safer treatment and management of these critically ill patients."

Another expert agreed.

"Up to now, hemorrhages deep in the brain have been hard to treat because surgery necessarily damages normal tissue to get to the blood clot," said Dr. Louis Cornacchia, director of neurosurgery at Brookdale University Hospital and Medical Center, in New York City. But the new catheter-based technique "not only allows more of the clot to be removed but also results in better outcomes for patients."

Cornacchia agreed that further, larger trials are needed to confirm the results. "However, if this study is validated, it will point the way to a standardized treatment of a common, very stubborn medical problem," he said.

The findings were scheduled for presentation Thursday at the annual meeting of the American Stroke Association in Honolulu. The study also will be published simultaneously in the journal Stroke.